<center>
<BR>
<table>
	<tr>
		<td style="text-align:left;vertical-align:top;">
			<table id="SCTV_Filters" cellpadding="0" style="width:250px; border-spacing: 3px;">
				<tr>
					<td style="width:13%;">{$form_maintenance_code.label}: <strong id="form_charge_maintenance_code"/></td>				
				</tr>
				<tr>
					<td style="width:13%;">{$form_customer_name.label}: <strong id="form_charge_customer_name"/></td>				
				</tr>
				<tr>
					<td style="width:13%;">{$form_street.label}: <strong id="form_charge_street"/></td>
				</tr>
				<tr>
					<td style="width:13%;">{$form_phone.label}: <strong id="form_charge_phone"/></td>					
				</tr>
			</table>
		</td>
		<td>
			{$form_open}
			<table id="SCTV_Filters" cellpadding="0" style="width:200px; border-spacing: 3px;">
				<tr>
					<td class="epesi_label" style="width:30%;">
						{$form_charge.label}
					</td>
					<td class="epesi_data" style="width:70%;">
						{$form_charge.html}
					</td>				
				</tr>
				<tr>
					<td valign="top">
						{$just_close.open}
						<div class="epesi_big_button">
						<img src="{$theme_dir}/Base/ActionBar/icons/save.png" alt="" align="middle" border="0" width="32" height="16">
						<span>{$just_close.text}</span>
						</div>
						{$just_close.close}
					</td>
					<td>
					</td>
				</tr>
			</table>			
			{$form_close}
		</td>
	</tr>
</table>
</center>